Cervical Disc Prolapse
Cervical disc herniation can present as Radiculopathy (nerve root compression causing arm pain) or Myelopathy (spinal cord compression causing balance/gait issues). Differentiating the two is critical.
1. Common Levels & Roots
In the cervical spine, the root exits above the corresponding vertebra (unlike lumbar). C5-C6 disc affects C6 root.
- C5-C6 Disc (C6 Root): Weakness in Biceps/Wrist Extension. Numbness in Thumb/Index. Loss of Biceps Jerk.
- C6-C7 Disc (C7 Root): Most Common. Weakness in Triceps/Wrist Flexion. Numbness in Middle finger. Loss of Triceps Jerk.
2. Clinical Tests
- Spurling's Test: Neck extension + Rotation to affected side + Axial compression. Reproduces arm pain (Radiculopathy).
- Shoulder Abduction Sign (Bakody's): Patient places hand on head to relieve pain (Reduces nerve tension).
- Myelopathy Signs: Hoffman's sign, Inverted Supinator Jerk, Hyperreflexia, Babinski.
3. Management
- Conservative: Cervical collar (short term), Traction, PT.
- Surgical: ACDF (Anterior Cervical Discectomy and Fusion) is the gold standard. Posterior Foraminotomy is an option for lateral soft discs.
25 Practice MCQs
Q1. C6-C7 Disc herniation compresses which nerve root?
Answer: B). In cervical spine, C7 exits between C6 and C7.
Q2. The most common level for cervical disc herniation is:
Answer: C). Followed by C5-C6.
Q3. Spurling's Test involves:
Answer: A). Narrows the neuroforamen.
Q4. C6 Radiculopathy causes sensory loss in:
Answer: A). Lateral forearm and thumb.
Q5. Cervical Myelopathy presents with:
Answer: A). Cord compression signs (UMN).
Q6. Hoffman's Sign is:
Answer: A). Indicates Myelopathy.
Q7. Weakness of Triceps and Wrist Flexors indicates damage to:
Answer: C). C7 is the main extensor of the elbow.
Q8. Shoulder Abduction Relief Sign (Bakody's sign) usually relieves pain in:
Answer: A). Relieves tension on the nerve root.
Q9. ACDF stands for:
Answer: A). Standard surgical procedure.
Q10. Soft discs vs Hard discs:
Answer: A). Hard discs (osteophytes) are common in elderly.
Q11. C5 Radiculopathy affects which muscle mostly?
Answer: A). Also Biceps.
Q12. Lhermitte's Sign is:
Answer: A). Suggests cord compression or Multiple Sclerosis.
Q13. C8 Radiculopathy causes weakness in:
Answer: A). Numbness in little finger.
Q14. Cervical Traction is contraindicated in:
Answer: A). Can cause cord injury.
Q15. Uncovertebral Joints (Joints of Luschka) are found:
Answer: A). Their hypertrophy causes foraminal stenosis.
Q16. Dysphagia (difficulty swallowing) is a potential complication of:
Answer: A). Retraction of the esophagus/pharynx.
Q17. Chin Tuck exercises help to:
Answer: A). Core stability for the neck.
Q18. Vertebral Artery insufficiency symptoms (5 Ds) include:
Answer: A). Screen before manipulation!
Q19. Artificial Disc Replacement (ADR) in cervical spine aims to:
Answer: A). Alternative to fusion in young patients.
Q20. Inverted Supinator Jerk indicates:
Answer: A). UMN sign at C5/6 level.
Q21. Upper Limb Tension Tests (ULTT) are used to:
Answer: A). ULTT 1 (Median), ULTT 2 (Radial), ULTT 3 (Ulnar).
Q22. "Stinger" or "Burner" in athletes is:
Answer: A). Common in contact sports.
Q23. Horner's Syndrome (Ptosis, Miosis, Anhidrosis) can occur with:
Answer: A). Sympathetic chain involvement.
Q24. Scapular winging in cervical radiculopathy suggests injury to:
Answer: A). C5/6/7 roots supply Serratus Anterior.
Q25. Is soft collar recommended for long-term use?
Answer: B). Use briefly (2-3 days) for acute pain only.
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